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General NPI Number Information
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NPI Number | 1144761461
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Entity Type | Individual
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Provider Name | GARY SIMMONS
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Gender | Male
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 103 MEDICINE WAY
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City | PERIDOT
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State | AZ
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Zip | 85542
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Country | US
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Telephone | 928-475-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 58135 RANDOLPHS DR
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City | PLAQUEMINE
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State | LA
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Zip | 70764-7430
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Country | US
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Telephone | 985-515-3102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13029
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License Number State | LA
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